APPROACH TO THE PATIENT

WITH CARDIOVASCULAR DISEASE JULIANA G. TAMAYO M. D. THE MAGNITUDE OF THE PROBLEM CVD COMPRISE THE MOST PREVALENT SERIOUS DISORDER IN 2002 - 62M AMERICANS ( 1.e MORE THAN 1 IN 5 PERSONS) HAS CVD - RISES PROGRESSIVELY WITH AGE: 5% AT AGE 20 TO 75% AT AGE > 75 YEARS IT HAS BEEN PROJECTED THAT BY 2020 CVD WILL BE THE LEADING CAUSE OF DEATH WORLDWIDE

MYOCARDIAL OR CORONARY FUNCTION THAT MAYBE ADEQUATE AT REST MAYBE INADEQUATE DURING EXERTION.

CHEST DISCOMFORT OR DYSPNEA THAT APPEAR ONLY DURING ACTIVITY ARE CHARACTERISTIC OF HEART DISEASE WHILE THE OPPOSITE PATTERN 1.e THE APPEARANCE OF THESE SYMPTOMS AT REST AND THEIR REMISSION DURING EXERTION IS RARELY OBSERVED IN PATIENTS WITH ORGANIC HEART DISEASE. PATIENTS WHO ARE ASYMPTOMATIC BOTH AT REST AND DURING EXERTION- BUT MAY PRESENT: - ABNORMAL PHYSICAL FINDINGS HEART MURMUR ELEVATED ARTERIAL PRESSURE - ABNORMALITY OF THE ECG - ABNORMALITY OF THE CARDIAC SILHOUETTE ON THE CHEST ROENTGENOGRAM - (+) STRESS TEST

DYSPNEA- ONE OF THE CARDIAC MANIFESTATIONS OF HEART FAILURE IS NOT LIMITED TO HEART DISEASE BUT IS ALSO OBSERVED IN: PULMONARY DISEASE MARKED OBESITY ANXIETY